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Physicians not trying to obstruct patient access

By Mary Deutscher


SASKATOON — The College of Physicians and Surgeons of Saskatchewan (CPSS) will open another public consultation in the weeks ahead, following the approval in principle of a revised policy on conscientious objection for the province’s doctors.

The new policy will require physicians to “make arrangements” for their patients to access treatments that the physician finds morally objectionable. Further, the policy requires that physicians provide treatment when it “must be provided within a limited time to be effective.” In their discussion, the council acknowledged that most physicians to whom this policy applies sincerely want the best outcomes for their patients and are not trying to obstruct patient access to care.

The policy identifies three scenarios in which a physician may wish to withdraw his or her services from a patient. First, when a patient requires information about possible treatments; second, when a patient requests a specific service; and third, when a patient requires a specific treatment in an emergency.

The council’s discussion of the policy began with the second of these scenarios, considering the role of the physician when a patient requests a service to which the physician has a conscientious objection. The council deliberately avoided requiring the physician to provide the patient with a formal referral, stating instead that the physician should “make an arrangement that will allow the patient to obtain access to the health service if the patient chooses.”

The policy further clarifies that the physician’s obligation “will generally be met by arranging for the patient to meet with another physician or other health care provider who is available and accessible and who can either provide the health service or refer that patient to another physician or health care provider who can provide the health service.”

Much of the discussion around previous drafts of the policy concerned the moral implications of making a formal referral. Most physicians who have moral objections to procedures such as sex-selective abortion are willing to provide patients with information on how to legally access the procedure, but are not willing to be directly involved by providing a referral. As Cardinal Thomas Collins explained in his March 24 letter concerning a similar policy in Ontario, “by insisting they provide an effective referral on (matters of conscience), in essence, the physician is being asked to serve as an accomplice in the procedure.”

However, it is not clear whether the current draft’s wording of “making an arrangement” is the equivalent of making a referral. A brief submitted to the CPSS on behalf of the Christian Medical and Dental Society (CMDS) Canada, the Canadian Federation of Catholic Physicians’ Societies, and Canadian Physicians for Life argued that the policy’s requirement that physicians simply “make arrangements” with another doctor for information and provision of treatment is in fact a formal referral that effectively makes a doctor with a conscientious objection complicit in a treatment to which the doctor objects.

In situations where the physician is not comfortable providing information regarding a treatment, the physician’s obligation “may be met by arranging for the patient to obtain the full and balanced health information.”

Regarding emergencies, the CPSS council adopted a section that reads: “Physicians must provide medical treatment for a patient within the physician’s competency where the patient’s chosen medical treatment must be provided within a limited time to be effective and it is not reasonably possible to arrange for another physician or health care provider to provide that treatment.”

Concerns were raised that this section could be interpreted to include physician-assisted suicide or euthanasia.

The CPSS has also now established a subcommittee to address the issue of “physician-assisted dying,” which according to a Supreme Court of Canada ruling could be legally available in Canada as of Feb. 6, 2016.

The current conscience rights policy follows a previous draft that proposed a regime in which Saskatchewan doctors would be compelled to refer for, and in some cases provide, morally objectionable treatments. The early draft was met with criticism during a public consultation in which the vast majority of some 4,000 submissions supported conscience rights. The policy was sent back to a subcommittee for redrafting following the March 28 meeting of the CPSS council.

The Roman Catholic Diocese of Saskatoon, the Canadian Medical and Dental Society (CMDS) and the Canadian Federation of Catholic Physicians’ Societies (CFCPS) have all spoken out against the previous draft of the policy.

A recent Abingdon Research poll found that more than 53 per cent of Saskatchewan residents said that “nothing should happen to the doctor” who was unwilling to provide a treatment or a referral for reasons of moral conviction.

“Saskatchewan residents seem confident in their ability to seek treatment options elsewhere when they and their doctors have a difference of opinion. Saskatchewan patients are willing to respect their doctors’ conscience rights. Why isn’t the CPSS willing to give their own members the same respect?” queried CMDS executive director Larry Worthen.

“We need to have physicians who are free to bring their whole selves to their patients, including their compassion and their ethics,” said Saskatoon Bishop Donald Bolen. “I appreciate the CPSS council’s willingness to address this issue and I am optimistic about the approach they have taken. I hope they will continue to work together with the people of Saskatchewan to find clear language that protects both patients and physicians.”

The CMDS and the Canadian Federation of Catholic Physicians’ Societies filed an application March 24 asking the Ontario Superior Court of Justice Court to declare that portions of a similar policy passed in Ontario violate the Canadian Charter of Rights and Freedoms. Physicians for Life have since joined them in their application.

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